Healthcare Provider Details

I. General information

NPI: 1891815791
Provider Name (Legal Business Name): JOSEBELO D CHONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E MARCH LN SUITE C 300
STOCKTON CA
95210-6629
US

IV. Provider business mailing address

1801 E MARCH LN SUITE C 300
STOCKTON CA
95210-6629
US

V. Phone/Fax

Practice location:
  • Phone: 209-464-6422
  • Fax: 209-464-0193
Mailing address:
  • Phone: 209-464-6422
  • Fax: 209-464-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC135303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: